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Kinetosis: All you need to know.

Authors:
  • Kings University Odeomu Osun state Nigeria
63
Journal of Biotechnology Science Research.2014;1(3):63-74
Review paper
Kinetosis: All You Need To Know
a,b Ukaegbu Chinonso Ishmael*, aShah Samiur Rashid, bUkaegbu Benjamin Chibuike
a Faculty of industrial science and technology, Universiti Malaysia Pahang (UMP), 26300 Gambang, Kuantan, Malaysia.
b Department of Medical Laboratory Science, Imo State University Owerri, Nigeria
ARTICLE INFO:
Article history:
Received: 11 September 2014
Received in revised form:
25 November 2014
Accepted: 1 December 2014 2014
Available online: 5 December 2014
Keywords
Kinetosis
Causes
Inorganic
Effects
Management
*Corresponding author
E-mail:Chinoreal1456@yahoo.com
Mobile: +601126653991, +234803898479
Introduction
Motion sickness or kinetosis, also known as travel
sickness, is a condition in which a disagreement
exists between visually felt movement and the sense
of movement in the middle ear. “Sensory conflict”
theory is one of the most established theories to
explain in which circumstances motion sickness
arises1. This theory assumed that motion sickness
originates from a sensory disagreement between
real versus expected invariant patterns of vestibular,
visual and somato -sensory inputs1.
It has been accepted that the vestibular system
influences individual motion sickness susceptibility
(MSS) since patients with bilateral vestibular deficit
have greatly reduced susceptibility or do not
become motion sick at all.2,3 This sensory mismatch
leads to an activation of vestibule autonomic
pathways, which have been shown to be also
involved in producing nausea and vomiting during
motion sickness and those that generate illness after
ingestion of toxins3. Depending on the cause, it can
also be referred to as sea sickness, simulation
sickness, car sickness, or airsickness4, its common
ABSTRACT
One of the major fears that grips about 50% of travelers, either by air, road ,sea
or any other means of transportation is a very uncompromising situation know as
motion sickness. This condition is branded “uncompromising” because ones it
sets in, nothing else matters, all attention must be focused on how to resolve it. In
medicine, it is called “kinetosis” because it is associated with movements. This
condition has made so many people to think a lot whenever they are going to make
any form of travelling, and has ultimately reduced some people to limited
distances and short destinations. It is also a source of worry to commuters and
passengers because a sufferer must be made to get him/herself if the situation gets
bad and everybody has to wait until the situation is calmed. This review is aimed
at checking the possible cause of kinetosis, its effects on the sufferer and how to
manage it. It also reviewed the prevalence of the sickness among adult and
children travelers.
Journal of Biotechnology Science Research (JBSR)
Journal homepage: www.jbsr.issres.net
Ishmael UC, Rashid SS, Chibuike UB 2014 / Journal of Biotechnology Science Research.2014;1(3):63-74
64
symptoms are dizziness, tiredness, fatigue, and
nausea and vomiting. In some case, headache has
been a symptom of kinetosis. Sopite syndrome in
which a person feels fatigue or tiredness is also
associated with motion sickness. Nausea in Greek
means seasickness (naus means ship) according to
Woodhouse's English-Greek Dictionary5. If the
motion causing nausea is not resolved, the sufferer
will usually vomit. Vomiting won't relieve the
feeling of weakness and nausea, which means the
person could vomit until the cause of nausea is
found. The person will even be feeling more tired
and tends to vomit more unless the cause of nausea
is resolved.
Causes of kinetosis
One of the best hypotheses for the explanation of
the cause of motion sickness is that it functions as a
normal way the body defends itself from toxins
through the help of the neurological centers in the
brain. The centers produce neurotransmitters such
as acetylcholine and dopamine which stimulates the
chemoreceptor trigger zone (CTZ) in the brain stem.
The activation of the CTZ receptors sends signals to
other vomit control centers to induce vomiting.
Various chemicals such as serotonin, dopamin, and
/or muscarinic and cholinergic receptors in the CTZ
are stimulated which leads to induction of vomit
through the coordinated generation of action
potentials with the vomit control area that ends up
in vomiting6. The toxins are usually perceived to
be neurotoxins7. The chemoreceptor trigger zone
(CTZ) which lies in the area postrema in the brain
stem made up the vomiting center which is
responsible for inducing vomiting when poisons are
felt in the gastro intestinal system, and for resolving
conflicts between vision and balance. A conflict
between the sense of sight and sense of balancing
usually puts the whole body in trouble and this is
usually resolved through the induction of vomit by
the vomit center in the brain. When motion is felt
but not seen (for example, in a ship with no
windows), the inner ear sends signals to the brain
that it senses motion, but the eyes tell the brain that
everything is still. As a result of the mismatch, the
brain will come to the conclusion that one of them
is seriously not sound and further conclude that the
hallucination is due to poison ingestion. The brain
responds by inducing vomiting, to clear the
supposed toxin. This is the real cause of vomiting
which will tend to remove the toxin from the body.
An alternative theory, also known as the Nystagmus
Hypothesis8, has been proposed based on activation
of the vagus nerves resulting from the stretching or
traction of extra-ocular muscles 4 co-occurring with
eye movements caused by vestibular stimulation.
There are three aspects of the theory: first is the
remarkably close linkage between activity in the
vestibular system, i.e., semicircular canals and
otolith organs in the middle ear, and a change in
tonus among each of the eye's six extra-ocular
muscles. Thus, with the exception of voluntary eye
Ishmael UC, Rashid SS, Chibuike UB 2014 / Journal of Biotechnology Science Research.2014;1(3):63-74
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movements, the vestibular and oculomotor systems
are thoroughly linked.
Second is the operation of Sherrington's Law9
which describes reciprocal prevention between
agonist/antagonist muscle pairs, and by implication
the stretching of extra-ocular muscle that must
occur whenever Sherrington's Law is made to fail,
thereby causing an un-relaxed (contracted) muscle
to be stretched.
Finally is the critical presence of afferent output to
the Vagus nerves as a direct result of eye muscle
stretch or traction10. Thus, stimulation of the 10th
nerve resulting from eye muscle stretch is proposed
as the cause of motion sickness.
This theory is supported with the fact that people
without Labyrinthine are immune to motion
sickness and also why symptoms emerge when
undergoing various body/head accelerations; why
combinations of voluntary and reflexive eye
movements may challenge the proper operation of
Sherrington's Law; and why many drugs that
suppress eye movements also serve to suppress
motion sickness symptoms.
Types of motion sickness
Motion sickness can be divided into three types
depending on presentation
1. Motion sickness caused by motion that is felt
but not seen.
2. Motion sickness caused by motion that is seen
but not felt.
3. Motion sickness caused by mismatch of the
senses.
Motion is felt but not seen
In these cases, motion is sensed by the vestibular
system in the middle ear and hence the motion is
felt, but no motion or little motion is detected by the
visual system. Examples of such situation include;
Carsickness
Car sickness is very common and often shown by
ones inability to read a map or book during travel.
Trying to read a book, a map, even from an
electronic device, down to watching a movie inside
a moving car worsens the situation. Car sickness
results from the sensory conflict arising in the brain
from differing sensory inputs-sight and balance.
The eyes mostly see the interior of the car which is
stable while the vestibular system of the inner ear
senses motion as the vehicle goes around corners or
over hills and even small bumps. This is more
encountered when travelling a long distance on
poorly maintained roads. Therefore the effect is
worse when looking down but may be lessened by
looking outside of the vehicle or ahead of a driver,
making sights and gazes of far objects as movement
advances towards them.
Airsickness
Airsickness is a sensation which is induced by air
travel4. It is a specific form of motion sickness and
is considered a normal response in healthy
individuals. It is essentially the same as carsickness
but occurs in an airplane. However, some
Ishmael UC, Rashid SS, Chibuike UB 2014 / Journal of Biotechnology Science Research.2014;1(3):63-74
66
significant differences are that an airplane may bank
and tilt sharply and due to the small window sizes,
unless the passenger is at a window seat he is likely
to see only the stationary interior of the plane.
Another factor is that while in flight, the view out
of windows may be blocked by clouds, preventing
a passenger at the window from seeing the moving
ground or moving lower clouds. It is actually less
severe in air plane as the tires of the aircraft are not
making much contact with the ground but tilts and
bends may cause kinetosis.
Sea-sickness
Seasickness is a form of motion sickness
characterized by a feeling of nausea and, in extreme
cases, vertigo experienced after spending time on a
craft on water4. It is, again, essentially the same as
carsickness, though the motion of a watercraft tends
to be more constant. It is typically brought on by the
rocking motion of the craft11, or movement while
immersed in water12. As with airsickness, it can be
difficult to visually detect motion even if one looks
outside of the boat as water does not offer fixed
points with which to visually judge motion. Poor
visibility conditions, such as fog, may worsen
seasickness. Some sufferers of carsickness are
resistant to seasickness and vice-versa.
Centrifuges
Rotating devices such as centrifuges used in astronaut
training and amusement park rides such as the Rotor,
Mission Space and the Graviton can cause motion
sickness in many people. While the interior of the
centrifuge does not appear to move, one will
experience a sense of movement. In addition,
centrifugal force can cause the vestibular system to
give one the sense that downward is in the direction
away from the center of the centrifuge rather than the
true downward direction. Centrifugal movements set
the fluid in the middle ear into motion and if this
motion is not supported by sighting the motion,
kinetosis is imminent. When one spins and stops
suddenly, fluid in the inner ear continues to rotate
causing a sense of continued spinning while one's
visual system no longer detects motion.
Motion that is seen but not felt
In these cases, motion is detected by the visual system
and hence the motion is seen, but no motion or little
motion is sensed by the vestibular system. When
motion sickness is caused by imbalance from visually
perceived motion but poorly felt, it is called Visually
Induced Motion Sickness (VIMS)13.
Motion sickness due to films and other video
This type of sickness is particularly prevalent when
people are watching films on large screens but may
also occur in regular format theaters or even when
watching TV. They feel the movements on screen as if
they are being involved thereby seeing movement but
actually they are not feeling it. This imbalance leads to
perception that one organ is actually in a hallucinating
condition and needs to be resolved. In regular format
theaters, an example of a movie that caused motion
sickness in many people is The Blair Witch Project.
Theaters warned patrons of its possible nauseating
Ishmael UC, Rashid SS, Chibuike UB 2014 / Journal of Biotechnology Science Research.2014;1(3):63-74
67
effects, cautioning pregnant women in particular.
Motion than the average movie camera.
Home movies, often filmed with a hand-held camera,
also tend to cause motion sickness in those that view
them. The camera-person rarely notices this during
filming since his/her sense of motion matches the
motion seen through the camera viewfinder. Those
who view the film afterward only see the movement,
which may be considerable, without any sense of
movement. Using the zoom function seems to
contribute to motion sickness as well as zooming is not
a normal function of the eye. The use of a tripod or a
camcorder with image stabilization technology while
filming can minimize this effect.
Simulation sickness
Simulation sickness, or simulator sickness, is a
condition where a person exhibits symptoms similar to
motion sickness caused by playing
computer/simulation/video games.
The symptoms are often described as quite similar to
that of motion sickness, and can range from headache,
drowsiness, nausea, dizziness, vomiting and sweating.
Research done at the University of Minnesota had
students play Halo for less than an hour, and found that
up to 50 percent felt sick afterwards. This usually
affects people who already have a tendency to get car
sick or sea sick14.
The phenomenon was well known in popular culture
before it was known as simulation sickness. In the 1983
comedy film Joysticks, the manager of a local video
arcade says, "The reason why I never play any of these
games, well, they make me physically ill. I mean, every
time I look in one of the screens, they make me dizzy."
Motions that are seen and felt but do not
correspond
When moving within a rotating reference frame such
as in a centrifuge or environment where gravity is
simulated with centrifugal force, the Coriolis Effect
causes a sense of motion in the vestibular system that
does not match the motion that is seen.
Sometimes when riding a vehicle for a long time on a
badly maintained road at a very slow (1020 km/h)
speed the two senses fail to correspond. Due to the poor
road quality the vehicle will jerk too much giving a
sense of severe motion to the inner ear, but due to the
slow speed the eye doesn't sense a proportional amount
of motion leading to a sensation of toxicity and
subsequent nausea.
Motion sickness caused by strong offensive smell
Among factors that may contribute to motion sickness,
such as alcohol or hunger, the presence of strong smells
is very often reported by individuals who are sensitive
to motion sickness15.
General susceptibility
90% of individuals are reported having experienced
motion sickness at least once in their lifetime. Indeed,
motion sickness has been described as a normal
response to an abnormal situation, it’s never a disease
per se.
Table 1. Motion sickness experienced by adults and
children when reading in passenger vehicles 16
Ishmael UC, Rashid SS, Chibuike UB 2014 / Journal of Biotechnology Science Research.2014;1(3):63-74
68
QUESTION
ADULT
(%)
CHILDREN
(%)
Frequency
o f
motion
sickness
when
reading
43
69
15
9
17
9
9
3
8
6
9
3
Severity of
motion
sickness
when
reading
43
69
25
22
22
3
10
6
Individual differences in susceptibility
Age
Motion sickness does not affect children who has a less
developed sense organs, within two years of age, and
the elderly ones with a defective sense organs4,1.
Gender
In general, women are more prone to motion sickness
than are men4,1 but, female astronauts do not report
more frequent motion sickness than do male
astronauts4, meaning that there is no gender differences
in susceptibility.
Behavioral styles
Introverted individuals and field-dependent persons
appear to be more susceptible to motion sickness than
other individuals 4,1.
Effects of Kinetosis
Dizziness
One of the greatest effects of kinetosis on sufferer is
the feeling of dizziness long after the situation has been
resolved. Dizziness is an impairment in spatial
perception and stability. (Dorland's Medical
Dictionary)dizziness does not have a direct meaning
and can be referred to as vertigo, presyncope,
disequilibrium(Reeves et al 2008) or a non-specific
feeling such as giddiness or foolishness18.
Fatigue
Fatigue (also called exhaustion, tiredness, languidness,
languor, lassitude, and listlessness) is a subjective
feeling of tiredness which is distinct from weakness,
and has a gradual onset. Unlike weakness, fatigue can
be alleviated by periods of rest. Fatigue can have
physical or mental causes. Physical fatigue is the
transient inability of a muscle to maintain optimal
physical performance, and is made more severe by
intense physical exercise19,20,21. Mental fatigue is a
transient decrease in maximal cognitive performance
resulting from prolonged periods of cognitive activity.
It can manifest as somnolence, lethargy, or directed
attention fatigue. Medically, fatigue is a non-specific
symptom, which means that it has many possible
causes including kinetosis.
Vomiting
Vomiting (known medically as emesis and informally
as throwing up and numerous other terms) is the
involuntary, forceful evacuation of the contents of the
content of the gut through the mouth and the nose22.
Vomiting can be caused by a wide variety of
conditions; it may present as a specific response to
ailments like gastritis or poisoning, or as a non-specific
outcomes of disorders ranging from malaria, typhoid
fever and brain tumors. The feeling that one is about to
vomit is called nausea, which often presents first, but
does not always lead to vomiting in most cases if the
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offending situation is solved, but if not resolved, about
80% of nauseated conditions leads to vomiting.
Antiemetics, which are drugs that inhibits vomiting are
sometimes necessary to suppress nausea and vomiting.
In severe cases, where dehydration develops,
intravenous fluid may be required.
Loss of appetite
Food is not a matter of interest within two or three
hours post kinetosis. Sufferers usually complain of not
being able to eat after about two hours of kinetotic
episodes and tend to regain appetite after a long time
of rest and possibly a short nap. Appetite and strength
lost during the episodes of nausea and correspondent
vomiting that follows kinetosis is a major contributor
to the loss of appetite and exhaustive feeling.
Prevention and mitigation of motion sickness
Many have not come across the different ways of
preventing kinetosis when embarking on long distance
travels and it is very necessary that those that have
suffered this sickness know some of the things to do
when embarking on their journeys, because once a
sufferer is always prone to it. Some of the basic things
to do include.
Have something in your tummy
Although it is said that either eaten or not does not have
effect on the occurrence of kinetosis, it is strongly
suggested that sufferers eat at least 30 minutes before
setting up for their journey, sense or feeling of hunger
aggravates the possibility of having an episode of
kinetosis. Oily foods do give a great quenching effect
to the onset of kinetosis.
Have a beverage handy
While travelling, make sure to have a bottle of
beverage with you which you have to be taking as often
as possible. Water is a common beverage that does this
magic so often. Drink as often as you could because
when you keep having water in your tummy, the
feeling of a toxin which the brain detects during
sensory conflicts between the eyes and the sense of
balance will be minimized, thereby delaying the brains
response to initiate vomit as a cautioning effect. Get a
good night's sleep before you travel, eat a light lunch,
avoid alcohol, coffee and nicotine.
Have some candy
Taking some candies made of either ginger or garlic
has proved good to reduce or delay the possibility of
having kinetosis during travelling23, although the
mechanism of this action has not been fully
understood. Adding distractions such as listening to
music or using aromatherapy scents such as mint or
lavender also helps. Flavored lozenges may also help,
in particular ginger-flavored. Lozenges may also
function as distractions or, in the case of ginger, may
hasten gastric emptying.
Have no memory of past episodes
Having thoughts of the past episode of kinetosis
usually raises the chances of an attack and it is
recommended that sufferers try as much as possible not
remembering how the past experience was, because
this is going to trigger the brains’ vomit center to feel
the body is undergoing same conditions as before and,
an episode is always the next thing to follow. To avoid
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a repeat episode, always try to forget the last
experience you had during travelling and have a
positive mindset towards your journey.
Avoid movies and reading onboard vehicles
Watching movies and reading articles on a moving
vehicle contributes to kinetosis. Viewing video is less
often the cause of motion sickness than is reading.
Similarly, viewing video is less often the cause of
severe motion sickness than is reading. However, if
one considers only those respondents who do
experience motion sickness, then the severity levels for
both activities are similar. Motion sickness while
viewing video is less likely to occur for children than
for adults. When it does occur, it is less severe in
children than adults1.
Posture
Varying posture can affect the incidence and severity
of motion sickness symptoms. Recent research24
suggests that postural instability is one of the factors
that contribute to the overall sensory conflict that
underlies motion sickness. Making much head
movements is a contributing factor. Additionally, there
is evidence that lateral and fore-aft motion and forces
contribute significantly to motion sickness in
passenger vehicles4,25,26. However, one study
concluded that fore-aft pitch motion contributes twice
as much to motion sickness as does lateral roll
motion25. These findings are consistent with the notion
that lying down flat and facing up (i.e., supine),
generally helps to lessen the effects of motion
sickness1,4,28. Not only does this position modify the
main axes of the body relative to the motions and
forces of the vehicle, but it may also lead to better
overall postural stability, especially for the head.
Conversely, the standard vertical seating position
found in passenger vehicles is associated with a
significantly higher incidence of motion sickness4,25.
However, postural adjustments are not always possible
or practical in passenger vehicles, especially in the case
of the driver or when an individual is attempting to
view video on a screen that is mounted in a fixed
location. If adopting the supine position is not possible,
restricting head motion is a good alternative postural
adjustment25. Optimizing position to reduce motion or
motion perceptionfor example, driving a vehicle
instead of riding in it, sitting in the front seat of a car
or bus, or sitting over the wing of an aircraft is
important. Cabin location on a cruise ship does not
appear to influence the likelihood of motion sickness25.
Closing the eyes
Given the underlying conflict between the sense of
sight and sense of balance that can cause motion
sickness, another potential method for reducing or
stopping symptoms is to reduce or stop the conflicting
stimuli input by closing the eyes. Visual input is most
easily “turned off” by simply closing one’s eyes. If
individuals are not able to set their gaze and posture to
allow for a clear view of the forward scene and/or
peripheral view of the horizon, then closing of the eyes
has been shown to be of some benefit for reducing
symptoms of motion sickness1,4,30 Indeed, research has
shown that restricting the outside and/or forward view
Ishmael UC, Rashid SS, Chibuike UB 2014 / Journal of Biotechnology Science Research.2014;1(3):63-74
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within a passenger vehicle can actually exacerbate the
symptoms of motion sickness30.
Adaptation
Adaptation over time to the sickness-inducing stimuli
has been reported to be one of the most effective
methods for the long-term prevention of motion
sickness1,4,28. When you get use to a particular situation
over time, it will automatically stop having any effect
on you perception of its presence. The process of
adaptation involves extended exposure to an
environment containing conflicting visual-vestibular
stimuli, usually on multiple occasions and over an
extended length of time. The main disadvantages to
this prevention method are (1) persistent kinetosis until
adaptation is achieved, and (2) the need for frequent
access and exposure to the environment in question.
Though relief is not as immediate when compared to
effective drugs or other countermeasures, adaptation
generally provides more complete, innate and lasting
relief which is naturally established from motion
sickness symptoms and has no side effects28.
Treatment of kinetosis/motion sickness
Natural medicine
Out of nature's medicine cabinet comes ginger, in
capsule form or as natural ginger root, which soothes
intestinal disorders without stressing the stomach.
Massages using rosemary or basil oil or a few drops of
lemon balm taken the day before departure also help.
During the journey itself you can chew gum or suck on
a lemon or an ice cube made of ginger29. Another form
of natural ways of treating kinetosis is taking a nap,
lying comfortably and having good source of natural
air, and if nausea persists, find your way out of the
vehicle for a while.
Medications
Antihistamines
Antihistamines have been used to treat motions
sickness. Notably, the non-sedating antihistamines do
not seem to be effective for motion sickness treatment.
Induction of sleep is one of the most classified ways
effective medications works. Sleeping or taking a short
nap is a way of solving the imbalance that exists
between the motion seen and motion felt. Drugs that
does not induce effective sleep within a short period of
administration is usually not seen as an immediate
treatment to kinetosis. Sedatives are better for the
management of kinetosis because they works in
various ways-it will induce sleep, and also takes care
of the mucosal membranes for effective vomit control.
Examples of antihistamine medications to treat motion
sickness include: chlorpheniramine (Aller-Chlor),
cyclizine (Marezine), cyclizine HCI (Bonine for
Kids),dimenhydrinate (Dramamine, Dramamine
Chewable, Driminate), diphenhydramine (Benadryl),
meclizine (Antivert, Bonine, D-Vert, Dramamine II).
Side effects may include significant sedation,
drowsiness, dry mouth, blurred vision, and confusion
and urinary retention in the elderly.
Anticholinergic
Scopolamine (Transderm-Scop) is the most well-
known medication in this category. It has been shown
in clinical trials to be effective at preventing motion
Ishmael UC, Rashid SS, Chibuike UB 2014 / Journal of Biotechnology Science Research.2014;1(3):63-74
72
sickness. Scopolamine is most commonly
administered as a patch applied to the skin. Side effects
are the same as those of the antihistamines (sedation,
blurred vision, dry mouth, and confusion and urinary
retention in the elderly). Persons at risk for angle-
closure glaucoma should not take scopolamine.
Antidopaminergics
Two drugs in this category that have been successfully
used in the management of motion sickness include
promethazine (Phenergan, Pentazine) and
metoclopramide (Reglan). They effectively control
vomiting through the blocking of the dopamine
receptors in the CTZ and therefore blocking the
signaling of other vomit control centers for the
induction of vomiting. Both of these medications can
also cause significant sedation and in a few people,
movement disorders (for example, torticollis or
twisting of the neck, tongue protrusion).
Other Medications
Ephedrine and some amphetamines have been used
both to treat motion sickness and to counteract the
sedating effects of other medical treatments. Studies
have also shown a beneficial effect of caffeine when
administered in combination with other medications
for motion sickness30. Benzodiazepines have also
been useful for some people with motion sickness.
Examples include: alprazolam (Xanax), and diazepam
(Valium).
Antiemetic (anti-nausea) medications have been used
to control nausea and vomiting after motion sickness
has developed. Examples include: prochlorperazine
(Compazine), and ondansetron (Zofran)31.
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Cite this article as: Ishmael UC, Rashid SS, Chibuike
UB. KINETOSIS: ALL YOU NEED TO KNOW. Journal of
Biotechnology Science Research.2014;1(3):63-74
... Past research showed that persons are heavily involved in SNSs and some appear to have experienced SNS fatigue or burnout (Yamakami 2012). Fatigue (also called languor and exhaustion) is a subjective feeling of tiredness or lack of interest (Ukaegbu, Rashid, and Ukaegbu 2014). In general, burnout refers to long-term exhaustion and diminished interest in work (Hochberg et al. 2013). ...
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